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Singaporeans, especially, the elderly, are worried about the cost of health-care. The government is also worried and tries to push the cost to the public. In most cases, the actual cost may be affordable, but the perception is that the cost is getting out of hand.
To address this issue, we have created a convoluted system of different tiers of charges for different groups of people and a convoluted system of payment through the Medisave, Medishield and Medifund (labelled as the 3Ms). The Government is proud of the 3Ms but there is little enthusiasm for this approach outside Singapore (and, in case I am wrong, I stand corrected).
The system used in the British National Health System is better. The citizens receive free medical consultation with their personal doctor (and referrals to specialists made by these personal doctors) but have to pay for medication, which are prescribed by independent pharmacists. This is a practical system that does not require payment to the doctors. The doctors are paid by the state.
The concept works well and is a practical approach. Patients will see the doctors only it is necessary. Even if they see the doctor more often than necessary, the doctor will be able to handle it. There is little chance of abuse. Medication is charged at the commercial rate (but there may be some system of subsidy). It will prevent the patient from getting medication to sell to other people, e.g. foreigners who are not on the system.
How can we implement some of the concept of the British NHS in Singapore? I suggest that every resident should open an account with MOH. All treatment from the public sector hospitals (and some authorized private sector) should be charged to this account. At the end of each month, the payments are made to the providers and are collected from the respective payment sources (e.g. cash, Medisave or insurance). There is no need to levy charges at the point of use. This will reduce the perception of the high cost of health care.
Most people will be able to pay for the medical charges on the monthly bills, which can be deducted from Medisave. There is the risk of bad debts from people who refuses to pay the cash component. This is a risk that can be managed. The government face a bigger risk of the non-payment of taxes and have ways to prosecute people who do not pay. This can be applied to medical care.
For the elderly and the poor, the government can take care of a portion of the medical bills. This can be easily managed on the monthly statements. They can also deal with the cases of high consumption. In the worst case of abuse, the patients can be cutoff from access to the service.
I believe that the approach that I have described is practiced in Canada. I like this approach as it will reduce the workload of our medical facilities (who do not have to collect fees at the point of consultation) and also reduce the perception of high cost of medical care. Any extreme cases can be dealt separately, outside of the delivery of the service.
Tan Kin Lian
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